Introduction 1
It may seem counterintuitive to publish a special issue focused on mad methods as they are emerging within the expanding field of mad studies. Activists and academics might argue that mad studies has remained critical and grounded in communities of variously identified mad people in large part because it resists the kind of academic bureaucratization that such a special issue represents.2 Yet this collection was not conceived as a way into the ranks of academic recognition. Rather, the intent behind this special issue is to interrupt and make known how academic recognition of mad studies is occurring; it is our attempt to disrupt the process of academic legitimization by demonstrating how mad people and their/our allies use the tools of the academy to manifest something decidedly different – a multiplicity of methods to madness, so to speak. At the same time, Audre Lorde’s provocation that “the master’s tools will never dismantle the master’s house” serves as a poignant reminder of the contradictions and maddening maneuvers involved in trying to do critical mad work from within the academy.3
As an ever-emerging yet never-quite-emerged academic endeavour, mad studies is experiencing a pivotal moment. It is at-risk of losing its activist edge through bureaucratization and diffusion while it is also uniquely positioned to intervene in the very institutional order that it is becoming enfolded into.4 As mad studies is increasingly recognized and constituted within the academy, the risk of shedding its activist roots and losing touch with communities of survivors has never been greater.5 This collection, and this introduction, are intended to intervene in the de-politicizing (yet maddening) bureaucratic ordering of mad studies. Organized formations of mad studies can only be as critical as their organizers and are always at risk of falling into familiar power structures that seek institutional advancement void of any attempts at maintaining activist and community relations. As mad studies gains a niche within the academy, the question posed by disability studies scholar Tanya Titchkosky highlights the quandary of this recognition: “When we get in, what are we in for?”6
Part of both the liminality and the promise of mad studies lay in that the area formally exists in very few places and yet perpetually emerges from varied corners and crevices of scholarship, surviving a lack of institutional recognition and support while continuing to find robust engagement and excitement across diverse fields. In one way, the unruliness of mad studies seems to be that it exists almost nowhere and yet everywhere, even (or perhaps especially) in areas where it is unrecognized, unwanted, or otherwise outcast. Perhaps this speaks to the relevance of mad thought, experiences, conceptualizations, and methodologies within the crazy-making context of academia in the west.
While not lacking in history, robust engagement, or intersectional relevance, mad studies as its own field somehow seems to elude bureaucratic sedimentation, remaining perpetually on the academic margins; always explaining its presence through other fields’ requirements and lacking its own institutional status, including in the form of focused academic hirings. As an area of scholarship, or a field that never quite seems to count as a field just yet, it is often difficult to know how to group or where to place mad studies work to facilitate connections within the academy or apply for research funding. What gets captured methodologically under mad studies most often represents a diverse array of work that can have more in common with wherever else it is placed than with other mad-focused work. By engaging with the field and its history and methods reflexively, we hope that this special issue will bring some methodological grounding to mad studies, while also finding ways to thoughtfully resist the bureaucratic imperatives of the academy.
Placing a mad methods special issue in Disability Studies Quarterly (DSQ), which is open access and has a long history of centering work that might otherwise exist at the margins, offers a unique and powerful entry point into exploring some of the tensions involved in situating mad studies academically. It allows a discussion of some of the strains of being simultaneously placed everywhere and nowhere while holding on to the very real dangers involved in becoming institutionally recognized. It also positions us, as editors of this special issue who work in both mad and disability studies, as making authorial decisions around the inclusions and exclusions that shape this introduction and special issue. Yet, as will be further explained in the following section, mad studies cannot be singularly classified as a sub-discipline of disability studies. Nor can its history be primarily represented as an outgrowth of disability studies. While there have long been spaces of overlap between disability studies and mad studies (and movements), there have also long been tensions: disability studies encompasses a wide range of work that does not always align with mad studies and even its most critical work is sometimes at odds with the political commitments of critical mad-focused work.7
Containing twelve articles, this special issue is not intended to be representative of all mad methods and methodologies but presents a diverse exploration of the uses, limitations, ways of proceeding, and residues left behind through the purposeful doing of mad work. It brings together a range of people at different stages in their careers, working in different settings; many are in the humanities, some take an arts-based approach to their work, others are in social work, anthropology, history, and education. Taken together, the articles curated here speak to the commitments and history of mad studies, the changes in the field, the debates that have animated conversations among variously identified and situated people engaging in critical mad work, and the benefits and risks of the academic disciplining of our work. This special issue resists any strict adherence to or definitions of methods and methodologies. Rather, we approach methods and methodologies as ways of proceeding; as paths that emerge that may be idiosyncratic or systematic that allow someone to achieve their scholarly and activist goals within mad studies and beyond.8
As an area with deeper ties to social movements than academic traditions, the mad studies articles featured here each manifest and make knowable a type of activist engagement in their methodological offerings. Foregrounding and taking seriously mad people’s perspectives with the intent of making the world more livable is a central feature of the articles contained in this special issue. These are not only core tenets of the field, they are also political necessities given the ongoing dehumanization, marginalization, and persecution of mad people and those so labeled. Yet that is not the only contribution made by our authors. Excavating the methods and methodologies of madness included in this special issue continues the work of creating diverse yet critical ways of doing mad work rooted in multiplicity, compassion, cross-movement solidarity, liberation, and a deep commitment to creating a more just world. In this way, the different paths that emerge through each article represent a variety of ways of proceeding that honor mad life and knowledge. Our methodological offering in curating this collection is, in some ways, the diversity embodied within this special issue. It is our attempt to honor the history of mad people, activism, and communities while also making space for and inviting new ways of proceeding that may challenge what has come before, which includes this special issue. As mad studies becomes bureaucratically formalized, its status as marginal is shifting as well. This shift is something anyone with interest in the field must contend with as we collectively make meaning of the lineages, commitments, and future manifestations of mad studies.
Foundations and Formalizations
The interdisciplinary field of mad studies emerged out of the anti-psychiatry, Mad liberation and Mad pride movements, and student activism of the last 40 years of the twentieth century.9 Early mad activism in Canada includes the formation of the Mental Patients Association in Vancouver in 1971, and the Ontario Mental Patients Association in Toronto shortly thereafter.10 These dynamic activists engaged with the arts, social services, and academia. Mad communities, mostly in Vancouver and Toronto, became leaders in articulating critiques of the psy complex, drawing connections to psychiatry as a foundationally racist, sexist, homophobic, classist, ageist, and xenophobic practice. By spring 1980, mad activists began publishing their critiques, artistic creations, and research in a zine they named Phoenix Rising: Voice of the Psychiatrized.11 In 1988, anti-psychiatry activists Bonnie Burstow and Don Weitz published the pathbreaking edited collection Shrink Resistant: The Struggle Against Psychiatry in Canada.12 Featuring diverse articles, stories, poems, drawings, and testimonies by psychiatric survivors and allies, the offerings contained in Shrink Resistant were early to link vulnerability to psychiatrization with other oppressions, providing first-hand accounts of the over-psychiatrization of Indigenous people and women in particular. Phoenix Rising and Shrink Resistant went a long way to get the messages of mad activism out and grow the mad community, including the presence of scholar-activists.
Similar movements arose in the United States in the last third of the twentieth century. The Insane Liberation Front in Portland, Oregon (1970), the Mental Patients’ Liberation Project in New York City (1971), the Mental Patients Liberation Front in Boston (1971) and other organizations worked to free people from institutions and end psychiatric oppression.13 Movement participants and their allies created Madness Network News (MNN) in 1972 in the San Francisco Bay area to foster the psychiatric survivor and mad people’s movements. The publication of MNN ended in 1986. In 1988, David Oaks, and other movement leaders and participants created Dendron to carry on the work of the News. As we will discuss further below, despite their absence from some early accounts of the movement and later obfuscations, Black activists, including the Black Panthers, feminists, gay and lesbian liberationists, Chicanxs, and queer, trans, and Indigenous people worked – sometimes on their own, sometimes with white allies – to resist psychiatric oppression and carceral and other interventions into their lives and communities. These and other movements grew and expanded – and some divisions arose – in the 1980s and 1990s.
Throughout the last two decades of the twentieth century, the mad people’s movement persisted and intensified in the US, Canada, and elsewhere. Activists held their first Psychiatric Survivor Pride Day parade in Toronto in 1993.14 In 2000, mad activists both within and without the academy formed the Psychiatric Survivor Archives of Toronto (PSAT) as a repository for the records and more personal effects of psychiatric survivors, as well as other holdings, including original printings of Phoenix Rising.15 The Mad Students Society in Toronto, which emerged in 2005, was deeply engaged in peer support and advocacy work, attending conferences, and actively challenging the limitations of accommodations practices through radio and other venues. Their work symbolized, at least in part, a breakthrough into academic spaces where mad student perspectives had previously been absent. While historian-activists like Geoffrey Reaume and others were doing important work in Mad People’s History, it was groups like the Mad Students Society (and likely others) who began to imagine and articulate what academia could and should be and offer if it were truly engaging in mad studies. Many of these conversations unfolded on the Mad Students Society listserv, which became an important space for building community and pushing ideas to the forefront.
In 2010, a two-day conference called “PsychOUT: An International Conference for Organizing Resistance Against Psychiatry” took place at the University of Toronto, the first of several academic-focused efforts toward psychiatric abolition organized by the Coalition Against Psychiatric Assault (CAPA).16 Following the conference, CAPA, led by psy abolitionists Bonnie Burstow and Don Weitz, shifted their efforts toward ending the practice of electroshock as psychiatric treatment. To this end, they began holding yearly anti-shock protests on or around mother’s day, naming the event “Stop Shocking Our Mothers and Grandmothers” and calling attention to the intersectional vulnerabilities faced by women, particularly older, poor, non-white, and/or immigrant/refugee women, to being electroshocked as a form of psychiatric treatment.17 Albeit small, this annual protest has become international, with demonstrations against electroshock occurring in cities within Canada, the US, and Europe.
Addressing electroshock as a form of violence against women highlights the strong feminist underpinnings of the mad movement in Canada and elsewhere, where much of the organizing work has focused on highlighting intersecting oppressions and vulnerabilities through movement participants’ diverse stories of psychiatrization. As such, mad activism in Canada during this era was deeply entwined with anti-carceral, anti-racist, anti-sexist, and anti-poverty organizing. As much of the Canadian mad movement’s activism was led by psychiatric survivors, a lot of the work produced through the movement represents first-hand accounts, including memoirs, testimonies, and autoethnographic writing. Over time, the scope of mad academic work expanded beyond autoethnography and began emerging in diverse fields. Mad scholar-activists published about the injustices and erasures involved in psy entanglement, calling attention to the field’s long and ongoing history of racist, hetero/sexist, xenophobic, ableist, classist, and ageist underpinnings.
By 2010, there was enough momentum among a range of actors, primarily in Canada, the UK, and the United States to begin to think about journal special issues and edited anthologies. In 2013, Noam Ostrander and Bruce Henderson guest edited a special issue of Disability Studies Quarterly (DSQ) in which they introduced what they called “Madness Studies.”18 The editors briefly noted the origins of the emerging field, as well as the desire of some people working in disability studies to “trouble the borders of normal/abnormal and sane/insane.”19 The nine articles included in the special issue, which featured a range of approaches from autoethnography to literary and theater studies, to the study of the workplace (including the academy and academic discourse), to the use of LSD in psychiatry, introduced readers to an emerging, but not yet fully formed or articulated, critical approach to thinking about madness and the relationship between “madness studies” and disability studies.
At the same time, scholars, activists, and activist-scholars in Canada were at work on their own anthology, which they also published in 2013. With 23 chapters and a much more robust engagement with critical concepts and approaches, and the historical development of mad activism and mad studies, Mad Matters: A Critical Reader in Canadian Mad Studies, edited by B. A. LeFrançois, Robert J. Menzies, and Geoffrey Reaume went a long way toward concentrating the newly emerging field into a constellation of a few central concerns. This important volume established mad studies’ historical rootedness in anti-psychiatry and highlighted its commitment to survivor-produced knowledge, political action, and a critical, intersectional, anti-sanist praxis that dislodged madness from its biomedical moorings, as the defining features of the field.
Mad studies would include a wide range of actors, however. Despite their resistance to the psy industries and their commitment to survivor-produced knowledge, the editors of Mad Matters described mad studies as “multi-vocal.”20 They acknowledged that resistance to psychiatry has come from “a multiplicity of sites, and it has involved people from every conceivable social position and walk of life.”21 Although, as the editors noted, Mad people and mad cultures occupied the analytic core and embodied the “very spirit” of mad studies, the field was open to a broad range of people with lived experience and their allies, including critical psy practitioners (and defectors) and those who rejected a “Mad” identity for other critical identities. Mad studies, the editors declared, was committed to multidisciplinary inquiry, coalitional organizing, collective action, and social justice. This capacious approach to thinking about madness and mad people, formalized and displayed in the Mad Matters anthology, has led to the production of lively and dynamic scholarship and other cultural and artistic interventions.
It has also led to increasing concern about whether and how mad studies should be delimited. One place where contributors to mad studies have drawn (admittedly and intentionally fuzzy) boundaries is with disability studies. Both the 2013 DSQ special issue and Mad Matters recognized an indebtedness to disability studies.22 Yet tensions with disability studies, especially the social model of disability, seemed to be present in mad studies from the beginning. As early as 2000, British mad studies leader and self-identified survivor, Peter Beresford, asked: What have madness and psychiatric system survivors got to do with disability and disability studies? 23 Neither the DSQ special issue, nor Mad Matters, provided a direct answer to Beresford’s question.
That work would be taken up by three British researchers dedicated to critical engagement with social work and “mental health” education and advocacy, Helen Spandler, Jill Anderson, and Bob Sapey, in their edited volume, Madness, Distress and the Politics of Disablement, published in 2015. Through 20 chapters mostly contributed by British researchers, writers, activists, and advocates, this valuable book grappled with fundamental issues at stake in the everyday lives of survivors, users, and the more recently self-identified psychosocially disabled people. They also engaged with critical conceptual and theoretical concerns that mad studies scholars and mad activists had with disability studies, especially with the social model of disability.
The editors of Madness, Distress and the Politics of Disablement recognized that while there had been solidarity and collaboration among scholars and activists who often lived and worked in both fields, there had also been divides between mad studies and disability studies. The editors explained that “there has been a long history of political activism and theorizing about disability on the one hand, and madness and distress on the other, [yet for reasons that are both historical and structural] these debates tend to happen separately.”24 Spandler, Anderson, and Sapey produced their edited collection to fill this significant gap in the literature by providing readers with a more nuanced understanding of madness and the everyday political realities of engaging in social justice work.
After reading Madness, Distress and the Politics of Disablement, it becomes clear that there were significant political and conceptual points of confluence and divergence between disability and madness and distress. As the editors explained, mad and disabled people had often shared spaces in their fights for rights and justice, and in drafting foundational legal documents, such as the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD, 2008). Yet, at the same time, there existed within the social model of disability – the conceptual bedrock of disability studies and disabled people’s activism since the 1970s – a crucial conceptual divide between impairment and disability that did not account for mad theorizing and mad people’s lived experiences.
Despite the efforts of some disability studies scholars to write about what they sometimes referred to as “mental disability,” madness had been sidelined within disability studies by scholars and others who failed to think about the experiences of mad people and various constructions of madness in both critical and politicized ways.25 Put differently, the social model of disability, even in its most sophisticated and nuanced articulations, did not have the political or theoretical heft needed to wrench madness and distress from its biogenetic, psychiatric foundations. Yet the social model was the basis for the UNCRPD, which was co-authored by disabled people and psychiatric survivors (among others), and for disability rights and welfare legislation transnationally. It was the basis for the everyday claims for accommodations and supports in daily living, in education, and in the workplace, as well as demands for broader social inclusion.
The editors of Madness, Distress and the Politics of Disablement put it this way in 2015: “No matter how far disability scholars may debate impairment in relation to physical disability (claiming, for example, that not only disability, but also impairment is socially constructed), it would be rare for them to dispute the existence of impairment itself. In fact, we could say that the disability movement’s commands – for equal access, participation in independent living support – depend on the existence of impairment. However, no such consensus exists in mental health.”26 As fluid of a category as impairment may be within the social model, it is still generally understood as a category. However, different conceptualizations of mental and emotional life do not necessarily share a common orientation toward what becomes labeled as mental illness. While many people working within mad studies may embrace a mad identity, or even a diagnostic one, others, including proponents of anti-psychiatry, fundamentally reject that diverse ways of being should be considered impairments. Without a more robust critique, and some might say rejection, of impairment as it is conceived under the social model within disability studies and disabled people’s activism, mad studies scholars and mad activists could not form simple or straightforward alliances with disability studies and the disabled people’s movement.
The wide community of people engaging with mad studies took a much more critical approach to thinking about impairment. Some psychiatric survivors rejected the notion that madness was an “illness.” A broader range of people living with mental troubles or distress rejected a purely biochemical understanding of their experiences, making it nearly impossible to disentangle “impairment” (embodied experience) from the “disability” (external force) that may have caused, or shaped, it. In the theorization of mad activists and mad studies scholars included in Madness, Distress and the Politics of Disablement, disability was not imposed upon a pre-existing impairment (ala the strong or British social model), the two were intimately interrelated. Madness and the various interventions deployed in its name, they argued, were rooted in oppressive social relations and societal structures. The editors of the book made the important declaration that no matter how radical disability studies interventions may have appeared in 2015, they could not continue to defer to medicalized definitions and understandings of impairment, and by extension, madness.27
Considered an urgent matter when Beresford asked the question in 2000, it seems, twenty-five years later, that many of the same concerns around impairment and the social model of disability still animate discussions within mad studies. Yet they are not the only focus of this dynamic and exciting field. Two anthologies, Jasna Russo and Angela Sweeney’s Searching for a Rose Garden: Challenging Psychiatry, Fostering Mad Studies published in 2016, and Andrea Daley, Lucy Costa, and Peter Beresford’s Madness, Violence, and Power: A Critical Collection published in 2019 have further solidified the field’s engagement with survivor-produced knowledge and the critical study of violence within mad people’s lives.28 Searching for a Rose Garden, which emerged out of a two-day meeting of scholars from several disciplines, activists, and advocates organized by the Association for Protection Against Psychiatric Violence and held in Berlin in 2011, aimed to introduce and explore alternatives to psychiatry that built upon survivors’ knowledge and understanding of madness and distress, as well as their experiences with various interventions. As the group worked on the edited anthology over the next five years, they broadened their approach to include critical users of the psy industries. They explained that by the time they published their book in 2016, they had come to find a home in mad studies, which was unknown to them when they met in 2011.
Unlike their comrades who met in Germany in 2011, the editors of Madness, Violence, and Power had been long-time activists and leaders in mad studies in Canada and the UK when they produced their edited collection in 2019. In it, they worked to broaden the understanding of violence that is manifest in the lives of users and survivors and interrogate systemic and structural violence, at the same time that they explored mad people’s participation in “accountability and justice dialogues.”29 For too long, they argued, both popular and scholarly conversations about madness and violence alternated between the mad person as a victim of violence, and the mad person as the instigator or perpetrator of violence. Neither one of these usually spectacular accounts of violence addressed the everyday ways in which multiple layers of violence interacted in the lives of mad people. The contributors to the volume aimed to provide a correction to overly simplified accounts of madness and violence through their collection of work produced by a range of academics and activists.
As is evident from this brief overview, a robust, interdisciplinary field of mad studies was already emerging when Peter Beresford and Jasna Russo began work on their edited collection, The Routledge International Handbook of Mad Studies, which they published amid the global pandemic in 2021. Published almost ten years after Mad Matters, the International Handbook reaffirmed and reanimated long-standing areas of interest and concern and established new benchmarks in mad studies. Consisting of 34 chapters spread over five parts, all authored by people who identify as psychiatric survivors, the book explores the past, present, and future of the field.
The contributions to this ambitious volume range from more traditional, although critical, academic articles to shorter pieces that provide first-person and other accounts of survivors’ many experiences with madness, organizing, working within various mental health systems, and creating new knowledge. Mindful of critiques that mad studies privileges white, academic, global north voices and experiences, Beresford and Russo, and the volume’s many contributors, took a transnational approach to thinking about mad studies that is grounded in survivors’ experiences and activist work.
In reflecting on the long process of editing the book, which quickly turned into a process of co-creation, Jasna Russo encouraged readers and future researchers, authors, and activists to take up this process of co-creation, to dwell in the complexities raised by madness and mad studies, to turn their gaze from the individual mad person to society, and to extend that gaze beyond psychiatry to the wider network of mental health systems.30 Russo also asked: “Who is the ‘we’ in Mad Studies?” Who is included and where are the political, ideological, and disciplinary boundaries of mad studies? Analyzing and dismantling established hierarchies of knowledge is a central task of mad studies but what is created in their place is still an open question for most researchers and activists. Russo argues that we need to honor experience and difference without isolating them in separate spaces. We need to reclaim a “we” that signifies our multiplicity and intersectionality while we work to create coherence, community, and alliances. She left it up to readers to decide how best to make creative use of difference in their efforts to move toward change and a future that we can all inhabit.31 Russo invokes activist-author and co-editor of Mad Matters, B.A. Lefrançois, to make the bold claim that mad studies can exist “within or without academia, but never without community.”32 According to co-editor, Peter Beresford, when we think globally, and especially about the global south, we can perceive that the future of mad studies lay beyond a simple critique or rejection of psychiatry and the medicalization of madness. Like the many contributors to the volume, he encourages activists and authors working in mad studies to have a broader imagination for their field.
Bringing philosophical and theoretical coherence to mad studies, while at the same time moving beyond its roots in the Canadian and British Mad Pride and psychiatric survivor movements is a distinguishing feature of The Routledge International Handbook of Mad Studies. As Russo argues, “Mad Studies opens up avenues to contextualize and de-center psychiatric oppression and avoid the dead-end roads of identity politics.”33 She and other contributors to the volume emphasize that engaging in mad studies does not require embracing a mad identity. Late Indian activist-author, Bhargavi V. Davar, who contributed to the volume, was not alone in arguing that mad studies scholars must be intersectional in their research and in their movement organizing. She and her colleagues in India were/are part of the global movement of psychosocially disabled people working to transform mental health care and they were/are also part of the Zero Poverty Movement and the caste resistance and Indigenous peoples’ movements in India.34 Although Davar considered herself part of the mad studies community of scholar-activists, and an ally to people identifying as Mad, she and many of her colleagues in India did/do not identify as Mad. For them Mad is too narrow a descriptor in part because it depends on a critical relationship with psychiatry, which has its roots in western, particularly US, global north discourses and practices.35 As Davar, Beresford, Russo and others note, the future of mad studies is in local/global studies and activist organizing that immerse themselves in the maze of intersectionality, analyze and work to deconstruct or dismantle power relations, and align themselves with other social justice movements. These and other theoretical insights will be explored in the articles contained within this special issue.
Despite the International Handbook’s rich focus on destabilizing hierarchies and building an intersectional and interdisciplinary mad studies outside its historic center in the UK and Canada, Beresford uses the book’s Introduction in part to search for an ideological and theoretical forefather for mad studies (ala Mike Oliver, whom he names in the Introduction). Beresford finds him in Peter Sedgwick, an anti-psychiatry professional (educational psychologist) with lived experience. According to Beresford, Sedgwick’s Psycho Politics (1982) “rejected the prevailing individualistic medicalised model of ‘mental illness’ and saw societies as driving people into madness and distress.”36 Beresford further declares that “While mad studies has emerged in the twenty-first century as a pioneering new development, it is directly linked to the values and principles first emphasised by Sedgwick.” Beresford outlines these principles as “being ideologically positioned, collectivity, [and] building on alliances.”37
While Sedgwick’s work is no doubt a valuable contribution to critiques of anti-psychiatry as nihilistic in its negation of madness, one must ask why a movement as innovative and diverse as mad studies might feel the need to link itself to a western, global north, white, cis-gendered, male forefather. Given its broadly democratic roots in the psych-survivor movement, its deep commitment to destabilizing hierarchies of knowledge-power, and its emphasis on decentering whiteness, the academy, global north/western perspectives, and biomedical expertise, it seems out of place and unnecessary to link mad studies to Sedgwick. The theoretical, philosophical, ideological, and methodological space opened by mad studies’ innovative approaches to knowledge production and political action should be filled by new, more creative interpretations of the movement’s past, and a more explicit commitment to its transnational, anti-colonial, justice-oriented future. Perhaps future mad studies author-scholar-activists will write a different origin story for their field.38
With its international scope, its persistent efforts to decenter white, global north voices and experiences, and its close attention to the historical, philosophical, and theoretical underpinnings of mad studies, The Routledge International Handbook of Mad Studies offers a valuable new benchmark as we move into the second (or third or fourth?) decade of the field’s development.
Race and Transnational Mad Studies
As the International Handbook of Mad Studies and other edited collections make clear, mad studies has become increasingly multidisciplinary and international as the field has coalesced over the past several decades. A growing variety of authors, scholars, and activists are taking intersectional and dialectical approaches in their work, as well, attending to the identities, affiliations, structures, histories, and material relations that shape madness and mad bodies and the ways in which mad people are shaping (or have shaped) the worlds around them. The vitality and dynamism of the field, and its multidisciplinary and activist roots, have meant that it relies on different methodologies and theoretical orientations.
In this section, we think more explicitly about the importance of race and the growth of the global mad people’s movement in the development of mad methods and theories. We begin with a brief history of asylum medicine, the historical foundation for modern psychiatry, and the concurrent resistance to it. We then move into a discussion of the ways in which academics working in multiple disciplines and fields have begun to theorize race and madness within local and transnational contexts. We conclude this section by offering our thoughts for fostering mad studies in a way that remains mindful of its rich heterogeneity and its powerful historical roots.
Mad activism and mad studies have their historical roots in the asylum, the cultural and material origins of which are usually traced back to England and the establishment of the Priory of St Mary of Bethlehem, which later became known as the Bethlehem Royal Hospital, or simply Bedlam, in Bishopsgate, London in 1247. Over the next several centuries, continuing into the early twentieth century, settler colonists and enslavers from various European countries, and their descendants, constructed asylums throughout the world. The Hospital de San Hipolito, opened in Mexico in 1567, as well as asylums built in the United States, Canada, North Africa, Argentina, South Africa, New Zealand, China, Vietnam, and Fiji, among other locations, are the material sites of colonial rule and local governance.39 They are the spaces where knowledge–power was created, made known, enacted, and resisted, where systems of control and care shifted and changed over time, and where until the mid-twentieth century an increasing number of the world’s mad or otherwise disabled and disenfranchised populations were confined.
Resistance to asylum medicine is as old as the asylums themselves. It dates back hundreds of years in some locations. That resistance, which was increasingly led by former asylum inmates and their allies, coalesced over the nineteenth and early-twentieth centuries into a broad and diffuse movement to reform or abolish asylums, primarily in the United States and the United Kingdom.40 In the decades after World War II, efforts to dismantle asylum medicine, as well as broader critiques of psychiatry, which had gained a tenuous but powerful hold on modern life, increasingly solidified in the UK, US, and Canada, as well as other countries. The concurrent transformation of psychiatry into a more overtly reductionist, biomedical model operationalized through the American Psychiatric Association’s creation of the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 and its subsequent revised and expanded iterations in 1994 and 2013 in turn engendered a more widespread and better-organized transnational response to it and its often coercive and harmful, and sometimes deadly, interventions.41 The history of madness and asylums, and psychiatry more generally, is a long and dialectical one shaped by power and resistance, manipulation and survival, and the creation of diverse, and at times competing, communities and cultures of care and control. It is a living history that continues to shape our world.
By the early twenty-fist century, diverse movements of variously identified mad and psychosocially disabled people had emerged in countries and regions across the world. Some of them came together in Beijing to draft the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Adopted by the UN in 2006, and entered into force in 2008, the UNCRPD is considered an historic achievement by many activists and scholars, although critique of the Convention and the limits of human rights disability activism have also been articulated.42 Many of the most vocal activists and advocates of the CRPD, such as the Center for the Human Rights of Users and Survivors of Psychiatry, the Pan-African Network of People with Psychosocial Disabilities, the Trans-Asia Strategic Group of Persons with Psychosocial Disabilities, and the Global Mental Health Peer Network value the CRPD as a means of empowering variously identified mad and psychosocially disabled people and their allies to create their own systems of support and mental health care and to resist the imposition of western, global north bio-psychiatric interventions into their lives. The World Network of Users and Survivors of Psychiatry and the Committee on the Rights of Persons with Disabilities – the group of independent experts created by the CRPD to monitor compliance with the convention – consider the CRPD a legal revolution because it diverges significantly from previous mental health laws that have been based on a medical model of mental illness. According to those who helped draft it, the CRPD is the only legislation in international or domestic law that guarantees the rights of mad and psychosocially disabled people on a basis of “full equality” with others, and that makes no exception to legitimize acts of state and medical violence and abuse of mad people, which in the past, and in more contemporary settings, have been carried out in the name of science and treatment or under the guise of protecting mad people or the people around them.43
Despite the long and fraught history of asylum medicine and psychiatry, few early mad studies theorists attended to race or the imbricated development of psychiatry and transnational systems of racialized capitalism in their work. A possible exception was Sri-Lankan born UK scholar, Suman Fernando. The work that Fernando developed over three decades extensively and critically engaged the relations between psychiatry, psychology, and mental health and colonization, development, globalization, and racism. In an edited anthology published in 1995 titled, Mental Health in a Multi-Ethnic Society, Fernando critiqued the ability of psychiatrists to define and delimit “illness.” In naming power as intricately linked to interpretations of madness, Fernando wrote that: “Although wedded to an illness model of evaluating problems, psychiatry is not just a medical discipline; it is also a social institution. …The type of control and the recipients of its actions are essentially determined by the socio-political context in which it operates.”44 In identifying the processes through which psychiatry transformed largely subjective judgements into objective medicine, Fernando asserted that “racist perceptions of black, brown, red, and yellow people (so-called) have worked their way into this psychiatric system at all levels.”45 Fernando, like other critics of psychiatry, exposed its deep social and political roots, and at the same time called attention to its connections with race. His work has not been widely taken up within mad studies, however.
Activists and academics organizing from within various intersections and working in mad studies recognized the need to sustain attention on race and transnational political economies of care and control. In their contribution to Mad Matters, Rachel Gorman noted the importance of developing what they referred to as “transnational theoretical approaches” in mad studies. This, they argued, would enable activists, organizers, and scholars to move “past the deadlock of a simultaneous inattention to race and under-theorization of the global in relation to psychiatric disability and psychiatric surveillance.”46 They and others emphasized the need for mad methodologies and theoretical approaches to attend to the psy industries’ deep roots in colonialism and slavery, which continue to shape transnational capitalist political economies of care and control.
In the years after the publication of Mad Matters, Black disability studies scholars working in the United States elaborated on the importance of attending to race in considerations of what they, rather uncritically, referred to as “mental illness” or “mental disability.” In her reading of the Black Panther magazine, Sami Schalk noted the work that the Black Panthers did in the 1970s, often in coalition with other activist groups, to call out psychiatric abuse, including forced drugging and other interventions, in various carceral settings. She called this “Black disability politics,” and argued that: “The Black Panther Party (BPP) believed that overmedicalization of disability, illness, and disease depoliticized and individualized these experiences in ways that obscured the effect of the social and political on people's bodyminds, especially those from oppressed groups, who are more likely to be subject to state violence.”47 The politics of the Panthers highlighted, and made known to a wider public, the critical role of race and the long history of structural racism in shaping the development of psy knowledge-power and the carceral systems it in turn helped to build, as well as the resistance of incarcerated Black men to those interventions into their lives.
US poet and literary and disability studies scholar, Therí Pickens, has provided theoretical tools that enable us to take a specific case, like that of the Black Panthers, and broaden it out to a more general framework that accounts for race, in this case Blackness in the United States, and madness in the development of mad methods, and mad studies more generally.48 In her engagement with US Black speculative fiction, Pickens reminds us that “madness (broadly defined) and Blackness have a complex constellation of relationships” that are historical, cultural, and structural.49 These relationships require us to think intersectionally about madness and Blackness, or as she put it, to pinpoint the “facets of their intertwining,” which in turn enables us to “rest with the knots history and culture have created."50 As Pickens makes clear, we need to engage in our work from the middle of those intersections, always mindful of the forces that create them and the confluences and collisions occurring within them.
Pickens also makes the important point that when combined with critical race studies, mad studies becomes “beneficially disruptive as a way to call attention to Black madness as a viable social location from which people have been engaged.”51 Although some scholars are only beginning to think of them as such, mad Black bodies/people have long been and remain among the objects/subjects at the center of the making of psychiatric knowledge-power and systems of confinement. In his work, self-identified mad, black theorist, La Marr Jurelle Bruce, who is also working in the United States, takes this point one step further. He argues that Black madness/mad Blackness is a critical standpoint from which Black people have engaged with and critiqued the legacies of colonialism and slavery.52 Developing a mad praxis that attends to Blackness, and other manifestations of race, should be a central concern for mad studies scholars moving forward.
Echoing the insights of Ghanian literary theorist, Ato Quayson, who was working in disability studies when he published Aesthetic Nervousness in 2007, Pickens asserts that a critical reading praxis that positions it as an interactive process should be part of our approach to thinking about mad Blackness :: Black madness.53 She writes that she takes for granted "that the reading acts that privilege madness and Blackness are participatory." Reading madness and race, she explains, "requires participation in the form of decision-making on the part of the reader."54 Building off of Pickens’ insight, we contend that this critical orientation toward reading opens up space to think in new ways about sources and archives that have long been familiar to those working in disability studies and mad studies and to incorporate new sources and new archives into our work. It also makes room for what Bruce has referred to as "radical compassion" in engaging with madness in those sources and archives.55
In his investigation of the murder of Malcoum Tate, a mad Black man living in the US south during the second half of the twentieth century, Michael Rembis uses theoretical insights from disability studies and mad studies, as well as his own reading of the history of Malcoum Tate and the later uses of his murder by the self-proclaimed mental health reformer, E. Fuller Torrey, to make a powerful call for an expanded understanding of racialized violence in the lives and histories of mad people. By placing Tate and his family at the center of his analysis (even though Tate left behind few primary sources) and by situating Tate and his murder in a larger and longer history of slavery and the Jim Crow US south, as well as the expansion of an increasingly racialist and reductive psychiatric-carceral apparatus and the retrenchment of state support, especially for poor Black people living in the south, Rembis highlights the need for more stories by and about mad people of color in transforming the way we think about madness, violence, and care both in the past and in the present.56
It has become clear through the work of scholars of color, and others, who engage with Blackness and madness in their work, that we must attend to race and local/transnational systems and structures while we also think about individual and collective lived experiences and more immediate social relationships. The theories and methods that undergird and guide our work should be built upon a rigorous intersectional foundation. As mad studies continues to expand, and more people from outside it are increasingly drawn to it, we will have to do the difficult work of incorporating new and innovative ideas and approaches, while also grappling with whether and how we should define or delimit madness and mad studies.
Decolonizing Mental Health/Madness and the Expansion of Mad Studies
Increased attention to race within mad studies, as well as the transnational expansion of the psy complex alongside broad coalitions resisting it, are moving questions of colonization and decolonization to the center of critical mad work. As the brief history of asylums and psychiatry presented in the earlier section makes clear, wherever the psy complex goes, the need to resist, critique, re-frame, and push back against it seem to follow. This suggests that perhaps “decolonizing” mental health or madness might require doing something that exists entirely outside of current dominant psy orientations rather than merely critiquing these orientations. As Mark Rapley, Joanna Moncrieff, and Jacqui Dillon argue in their edited anthology, De-Medicalizing Misery, “the human costs of the medicalization of misery and madness outweigh any benefit that the metaphoric transformation of suffering into ‘disease’ may once have offered.” They, like others, question whether there may be “better ways to make sense of the range of human experiences we have come to know as ‘mental disorders.’”57 At the same time, however, transnational debates are also arising from those who benefit from being critical users of psy services. What is at stake in these expanding conversations about “decolonizing” madness and/or mental health is nothing less than authority over the production of meanings made of and interventions into all forms of non-normative human mental life.
Although “decolonizing” is a necessary and useful political move, it can be difficult to define or know what is meant by the terms “decolonizing mental health” and “decolonizing madness,” because most uses of these terms are ideological and not structural or material.58 China Mills, for example, states that “a project of decolonizing [psychiatry] is one of imagining different relationships between medicine and madness, and mapping ways of responding to distress that are not psychiatric.”59 This definition of decolonization avoids reproducing or expanding psy hegemony. Yet it does not completely abandon or restructure the relationship between medicine and madness, nor does it work to dismantle the racialized capitalist structures that undergird the medical industrial complex. This raises questions about the expanding transnational role of the psy complex and how it relates to material realities in the lives of people living in places often referred to generally as the “global South” or “developing countries,” some of which have never been colonized.60 Mills has written extensively on the transnational shift whereby mental health is being framed as one of the most pressing developmental priorities in countries and regions around the world. She argues that while on the whole, inclusion of mental health in developmental policy should be celebrated, she warns that critical examination of this inclusion is needed since “at times, the fields of mental health and development work together in producing individualized and psychologized responses to poverty.”61
Mills further questions whether psy-oriented mental health can or should be transnational, given its disavowal of difference, which is also at the heart of colonial discourse. To this point, she states that “understandings of distress that invoke ‘unsound mind’ or categorize people’s experiences into ‘symptoms’ …may need to be abandoned within any mental health projects that work to be equitable or draw upon a human rights framework.”62 This seems to suggest that despite the celebratory tone of inclusion entailed in prioritizing certain notions of biogenetic mental health within development policies, this very inclusion facilitates the expansion and reproduction of colonialism. Identifying a similar issue, Tanya Titchkosky and Katie Aubrecht examine how the World Health Organization (WHO) plays a central role in narrating a particular version of mental health and illness that then becomes exported around the world and implemented into policies with real consequences for the framing and treatment of “developing countries.”63 In mapping how the WHO defines mental health as a developmental priority, the authors show the continuation of colonialism through globalizing mental health projects, stating that “this is not to say that people do not suffer, but rather that this suffering, often explicitly conditioned by the colonial enterprise, is immediately abstracted and controlled as a medical problem at the level of the mind.”64 The expansion of psy-oriented paradigms and systems of intervention in mental health across the world demand robust anti-colonial, de-medicalizing responses.
Yet this is often easier said than done. Within the west, the application of hegemonic mental health frameworks to Indigenous people and communities reveal the complicated effects of colonialism. Indigenous scholar Dian Million identifies a naturalization and de-politicization of Indigenous trauma that occurs through the application of western mental health frameworks to Indigenous communities.65 Although deeply damaging due to their de-politicizing effects, Million contends that mental health frameworks can also be useful, as “the trauma jargon sometimes serve[s] to phrase the irresolvable anguish that might otherwise be inexpressible.”66 In this way, she points to the tensions involved in fully rejecting psy terminology without access to different types of frameworks that can account for both anguish and its links to social, political, and economic power relations. Without the repatriation of life and land, the application of mental health frameworks to Indigenous people and communities, who are suffering from the ongoing effects and legacies of colonialism, both frame these effects as individual medical pathology while also allowing for some expression of trauma and anguish, albeit a medicalized and de-politicized version of it.
The continuation of colonialism through applications of psy orientations to Indigenous social suffering is further excavated when considering the disproportionate focus on, and rates of, Indigenous suicide in Canada. In the preface of their book on Indigenous suicide, Roland D. Chrisjohn, Shaunessy M. McKay, and Andrea O. Smith discuss the need to produce their work partly due to “the incredible capacity of academic and applied fields dedicated to the phenomenon of Native suicide to impose near-impenetrable layers of misunderstanding everywhere.”67 The authors contend that medicalized framings are consistent with what they call the “Broken Indian Model” which presumes individualized shortcomings or failures on the part of Indigenous people that account for high suicide rates. Continuing the work started by early Indigenous mad activists in Canada in the 1980s, these authors identify the foundations of psychiatry as being anti-Indigenous, and discuss the implications of the over-psychiatrization of Indigenous people in particular.68 Recognizing the disproportionate amount of literature on Indigenous suicide given the relative size of the Indigenous population in Canada, the authors explain that beginning in the 1970s, Native suicide was not only identified as a problem, but a problem the Canadian government was willing to act upon. The authors state that this acting upon, including through the advent of suicidology, “is in keeping with the sort of western intellectual imperialism that has not just entirely misrepresented and misunderstood Native peoples, it has invited and coerced us into misunderstanding ourselves.”69 This work speaks to an internalization of colonial framings, where Indigenous people are coerced into understanding themselves through the lens of de-politicized medicalization, which works to uphold ongoing colonial oppression by making it more difficult to name social suffering as such.
While interventions that decenter western psy orientations toward non-normative mental life are necessary, it is less clear whether and how these interventions move toward achieving a goal of decolonization, particularly if decolonization is approached ideologically rather than materially. While some believe the dismantling of the hegemony of western psy knowledge-power can only be done through psy abolitionist work, others approach “decolonization” through seeking reform to psy industries, raising alarm as to whether imperial mental health frameworks can be kept relatively intact while somehow being conceptualized as “decolonizing.” One concern among activists and academics alike is that structural inequity rooted in colonialism and racialized systems of global capitalism get elided in even the most critical and forward-thinking conversations about global mental health, especially in “developing” countries. Without meaningful structural change at both local and transnational levels, the idea that the psy complex can be decolonized is questionable at best. The growing relevance of mad studies speaks at least as much to an expansion of bio-psychiatric colonialism as it does to decolonizing efforts. In this way, transnational expansions of mad studies are not necessarily something to be celebrated, in that they signal the continual colonial growth of the psy complex despite decades of mad critique and activism. Future mad studies work should attend to the transnational material structures of the psy industries, as well as their bid for ideological domination in discussions of madness and distress.
Is Mad Studies Necessarily Critical?
If you have come this far in the introduction, the answer to this question may seem self-evident. In theory, all mad studies work should be critical…right? Yet, this question raises many other questions, not least of which is: What makes something critical? And perhaps the question of criticality itself serves as an invitation to explore mad studies scholars’ uses of methods and methodologies as a thoughtful bridging between a researcher’s espoused intentions and the paths they take to achieve them. Methodology is a place to slow down and reflect on what one is doing and why and to purposefully direct research so that it more closely aligns with the researcher’s commitments and aims. In other words, methodologies present a space to bring the why and the how into dialogue, and for research grounded in activism with aims of pursuing social justice, the question of how could not be more important in finding ways to most effectively achieve the why. The methods and methodologies featured in this special issue present and discuss various paths and ways of proceeding that foreground madness and mad people. They provide self-consciously situated knowledges; our authors approach their methods with awareness that they live in embodied relation to the world and find expression from within various intersections. This relational orientation toward methods and methodologies, approached in diverse and distinct ways, is one methodological offering of this special issue.
Of course, doing critical scholarship requires more than thoughtfulness in approach; and we will unpack and explore some of the elements we find necessary for criticality within mad studies scholarship. That said, meaningfully incorporating madness, mad knowledges, mad histories, mad communities, and mad ways of proceeding go a long way toward producing critical mad scholarship. Given its roots in psychiatric survivorship and mad activism, mad studies has long found ways of acknowledging its constituents’ different relations with mental health frameworks while remaining rooted in the political convictions of mad orientations. For example, those in psychiatric survivor communities who continue to use various mental health services have historically referred to themselves as mental health service users or consumers, while remaining critical about these services and their limits. In her chapter on mad people’s legal activism in Mad Matters, Lucy Costa referred to the “generic acronym c/s/x” to signify the consumer/survivor/ex-psychiatric patient movement, explaining that identity politics within mad communities “have grown and changed beyond ‘patient,’ ‘psychiatric survivor,’ and ‘consumer.’” She, like others, recognized that “people use numerous terms to reflect political and non-political relationships or identities to the psychiatric system(s).”70 While terms such as “psychiatric consumer” are criticized by abolitionist positions like anti-psychiatry for not being critical enough, such framings allow people to dis-identify with psychiatric labels even as they continue to access relied-upon services. In this way, mad traditions have helped re-frame and de-medicalize what is otherwise the territory of dominant psy frameworks.
The role of psy identification within mad studies has been a topic of debate since the early formations of the field. In her chapter in Mad Matters, Shaindl Diamond reflects on building solidarity and community through anti-sanist, and not necessarily anti-psychiatry, praxis. She uses this central conceit as a path to continue building through difference. Tapping the Toronto, Canada mad community as a kind of case study, Diamond identifies developments in mad activism that have caused divisions between people self-identified as psychiatric survivors, mental health service users/consumers, or Mad. In complicating uses of psy language and resistance to it within mad communities, Diamond aptly states that: “While often identity politics debates centre around language, people are in actuality debating much more than the meanings of identity labels.”71 In this way, the labels people use to describe themselves and their experiences may be more fluid and strategic than ideological, with connections to community identification, access to resources, and potential policy implications as well. Diamond warns that while madness must be at the heart of mad community, “Essentializing both Mad discourse and psychiatric discourse has the potential to obscure how processes of racialization, gender, class, disability, sexuality, and other processes shape and define madness.”72 Re-framing language debates within mad studies to focus on the ways in which mad people might identify with different types of language in different contexts can allow for a more nuanced analysis of how psy language is taken up within mad studies.
Several articles included in this special issue draw upon and utilize dominant mental health language, with the authors providing critical engagement with their uses of various psy interventions. While the specific terms psychiatric survivor and mental health consumer or service user appear to be less popular in contemporary mad studies, the underpinnings of language debates remain. It is not uncommon to identify with psy diagnoses, language, and frameworks within present-day mad studies, and without the former terminology of “mental health service user/consumer,” the lines of language and criticality within mad studies appear even more murky than they have in the past. In their article inhabiting hermit crab essays as a mad methodology, Leanne Toshiko Simpson featuring Rowan McCandless and Sara Hashemi also at times inhabit and relate their experiences to psy diagnoses. Simpson states that the decision to draw on diagnostic language stems from within complex intersections, “knowing that our language is always limited but reaching towards mutual understanding, exploring structures and forms that might bring our diverging stories a little bit closer.” Remaining mindful of the larger implications of Audre Lorde’s admonishment, it seems that some activists and writers use the “master’s tools” to build and maintain communities that might not always be approved of, or even perceived, by the master.
In his article included in this special issue, José Miguel Esteban further highlights the multiple ways in which people navigate and inhabit psy language. Through an embodied choreographic commitment to creation-as-product, Esteban draws on concepts of depression and anxiety as both lived experiences and part of narratives of overcoming. Both Esteban and Simpson relate to disability studies and arts-based traditions of doing mad studies, with the authors bringing in critical reflections even as they identify with the psy language and interventions they find helpful. Importantly, the purpose of such work is not necessarily to delegitimize psychiatric diagnoses, but to engage critically in what it means to occupy a mad identity within the context of living, teaching, and writing madness. Both Esteban and Simpson demonstrate the power of method woven in, in themselves a form of praxis that invites readers to unpack their multilayered beings and doings.
In her contribution to this special issue, Nadia Mbonde speaks to identifications with psy diagnoses as a means by which to access support groups for variously diagnosed people, a necessary orienting starting point from which to pursue critical exploration of racial surveillance and policing within these groups. In unpacking group dynamics within online and offline spaces, as well as within diagnosis-specific groups vs. support groups for Black people with any diagnosis, Mbonde explores her experiences of belonging and relation as a Black mother navigating racism and built-in elements of surveillance and policing within mental health support groups. In her exploration of research-based theatre about military trauma, Lauren Spring considers what gets lost in conversations about veterans’ mental health, re-centering embodiment and dialogue by unearthing the exclusions facilitated through psy orientations, including the diagnosis of Post-Traumatic Stress Disorder (PTSD). All of these articles describe their uses of psy language as a bridge by which to access shared understandings, community, or needed supports. Still, these authors defy the reproduction of wholly medicalized narratives by analyzing and occupying these concepts and terminologies in other-than-medicalized ways. There are many reasons why scholars engaging in mad studies might take on or otherwise identify with psy language, not least of which is that for many people, psychiatric diagnoses can help facilitate self-understandings, find community, access various types of needed support and accommodations including leave from work or school, and thus can help to navigate terrains that may otherwise be more difficult.73
Strategic identification with psy labels can also facilitate dialogue about the fluidity of taking on particular labels and what these labels do materially rather than what they signal about individualized identity. For example, trans people pursuing access to medically transition require a psychiatric diagnosis of gender dysphoria to be able to qualify for hormones or gender-affirming surgery.74 In the DSM-5, gender dysphoria in adolescents and adults is defined as “A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration” and supported by at least two of six listed largely overlapping criteria describing an incongruence with one’s assigned gender and a strong desire to “be of the other gender.”75 This puts into focus the web of navigation required of many trans people: whether or not they believe themselves to have a psychiatric disorder, they must seek this diagnosis in order to access paths towards transitioning. In this way, identifying with a diagnosis may be more practical than ideological, but it still creates a situation whereby trans people are constructed as being mentally ill for the very reason of being trans, and must accept this label to access medical support.
It is important to recognize that psy terminology and concepts are entangled within everyday relations, including in ways that allow people to understand and express themselves and their experiences and to access important material resources. Yet it is not inevitable, nor even necessary, that identities be articulated through the psy industries. The historicizing and “decolonizing” work of mad studies makes this clear. As the exportation of western mental health paradigms continues and intensifies, so too does the transnational relevance of mad studies. As a particular type of bio-psychiatric knowledge-power gains in its transnational dominance, it is crucial to foreground that the ways meanings are made of madness are not universal. Debates about identification and dis-identification with psy concepts in the west/global north and transnationally are coming to mirror decades-old debates about identity within the mad people’s movement not because these concepts are necessarily robust, but because they are becoming thrust upon increasing numbers of people around the world through colonial psy expansions and the political economies of care and control that value them.
The neurodiversity movement is yet another place where the tensions around diagnoses and criticality manifest in mad studies. While relatively recent, the neurodiversity movement is powerful and fast growing, largely formed through online and academic communities. Recent scholarship highlights the need to develop neurodiversity as a fluid and intersectional movement in recognizing its entanglements with trans, queer, mad, and racialized identities.76 Functioning as an umbrella term that re-frames otherwise sanist and ableist diagnoses including autism, ADHD, and other psychiatric labels connoting non-normative experience or functioning, neurodiversity was developed and theorized collectively by autistic activists in the mid-1990s primarily in the Independent Living autistic community email list.77 The term neurodiversity represents an outgrowth of discussions on neurological diversity within autistic-led online groups, the basic premise of which is that everybody is different and these differences are needed and should be valued rather than cured or eliminated.
Initially imagined as an intersectional rights-based movement calling for taking seriously the perspectives of people labeled as autistic, the neurodiversity movement has grown vigorously in a relatively short time, expanding its parameters offline and to encompass large overlaps with racialized, queer, mad, and trans communities and scholarship. Through claiming or reclaiming neurodiversity, people with or without psychiatric diagnoses come to recognize and embrace what they may otherwise have previously experienced as atypical or non-normative ways of being. In so doing, many people seek diagnoses in adulthood or otherwise claim self-diagnoses of neurodivergent identities. Still, without clear excavation of underlying assumptions of difference as rooted in biology, neurodiverse reclamations risk reifying rather than challenging a version of “impairment” that is consistent with the medical and social models of disability. The interchangeable use of madness with mental disability within many discourses around neurodiversity further calls into question whether and how this terminology fits within mad studies.78
The movement of diverse people, many of whom have not otherwise been psychiatrized, seeking out diagnoses and claiming medicalized identities, even in non-medicalized ways, presents an opportunity to explore and disentangle the relations between psy concepts and mad studies. In their article exploring the openings of dialogue between mad studies and neurodivergence, Brigit McWade, Damian Milton, and Peter Beresford identify an important overlap in that both areas critique hegemonic medical models that fail to include, account for, and adequately address lived experience perspectives within processes of knowledge production. The authors note that much of the overlap between mad studies and neurodiversity occurs under the auspices of disability studies, with the potential of this overlap to bridge historic debates about the role of impairment that separates mad studies from disability studies. Still, debates about the language of impairment allow for what the authors identify as “alliance activism” rather than direct overlap between mad studies and neurodiversity, since “the proposition from the neurodiversity movement is that we should reclaim and redefine ‘impairment,’ in the same way as the first disability rights activists challenged the meaning of ‘disability.’”79 For the neurodiversity movement, the authors posit, taking seriously and valuing embodied differences could aid in removing negative connotations from the concept of impairment.
Fluidity within the definitions, identifications, and embodiments of neurodiversity within the neurodiversity movement have facilitated some overlap with various queer and trans movements. Non-normative ways of being and expressing one’s mental life are increasingly understood by some activists and academics as not being discrete from non-normative ways of inhabiting/presenting gender identity and/or sexuality. Using the terms neurodivergence, madness, and mental disability interchangeably, J. Logan Smilges intentionally attempts to foster “coherence across differences,” to construct the possibility of a neurotrans identity, analytic, and politics that attends to the erasure of psychiatrized and mad racialized people from histories of queer and trans activism.80 Smilges speaks to more than an overlap in identities, but to a theorizing from the middle of these intersections in ways that can allow for dialogue across difference that resists erasures of race and class from dominant discourses about neurodiversity and transness. Indeed, we have spent time in this introduction attending to erasures of race, class, colonialism, and gender from mad studies, despite persistent efforts by some to resist and challenge these erasures. In highlighting the intersections between neurodiversity and transness, Smilges fosters a space in which the erasures of multiply marginalized people are surfaced and articulated. Still, some of the confluences involved in the interchangeable use of “neurodiversity,” “madness,” and “mental disability” risk creating their own erasures while reifying hegemonic psy concepts.
Within a mostly western neurodiversity discourse, reclaiming of medicalized language also entails pushing back against the status of this language as wholly medical, thus creating a kind of hybrid that combines elements of a medicalized orientation (i.e. the assumed premise that one’s brain chemistry or neurofunction is non-normative) with cultural elements formed through online (and other) spaces for these reclaimed identities. In critiquing the limits of metaphorized fluidity, Anne McGuire states, “Despite the seeming openness and fluidity of the spectrum metaphor, this spectral conceptualization of autism nonetheless functions as a way to further classify, and so further pathologize, the minutia of autistic difference.”81 In moving away from a singular focus on autism, part of the strength of the neurodiversity movement lays in its ambiguity and its incomplete but powerful rejection of medical authority over identity. Yet without meaningful debate about the reproduction of psy hegemony through the reappropriation of its terminology and concepts, the movement perpetuates psy authority over human differences, maintaining rather than challenging a decidedly western and medicalized gaze.
From the Margins to the Center: A Modest Conclusion
Throughout this Introduction, we have shared our perspectives, questions, critiques, and hopes for mad studies. Part of our methodology lay in decisions around which mad work to feature and the necessary exclusions involved in not being able, or wanting, to cover everything. While we have resisted claims of individuals founding the field, we have continuously returned to the community and activist foundations of mad studies; a different type of founding status, but a founding status nonetheless. Clearly, these are not the only foundations or orientations toward the field and its history. Some of the articles contained in this special issue come to mad studies through Fanon, Levinas, Laing, and others; none of whom are featured in this introduction despite being foundationally important to many approaches to mad thought and mad studies. None of the articles featured in this special issue prominently engage with Foucault, who for decades has been centrally important within diverse mad theorizing. These and the many other exclusions entailed in writing this introduction speak less to their lack of significance and more to our methodological commitment to staying close to mad and psychiatric survivor activism in tracing part of the history and formations of mad studies. There are many other histories that can and should be written.
We began our introduction by placing mad studies at the margins – academically and otherwise. And yet, as we write this, mad studies is on the move. This is not to suggest the field is somehow in a privileged position, as research funding, material formalizations (such as academic hirings or mad studies departments), and general valuing of mad work from outside of mad studies continue to remain largely elusive. Still, it is increasingly difficult to conceive of mad studies as entirely on the margins, at least in the ways it has been until this point. Foucault’s project of demonstrating the relations between the margins and center foregrounds the importance of the margins in revealing dynamics of power within the center that often otherwise go unnoticed. After all, without the margins defining the boundaries and fringes of something, what exactly is a center anyway, and what is it a center of? For better or worse, the bureaucratization of mad studies is working to center what has until now been marginal and informing the center. If mad studies is becoming its own center, then what might be growing at its fringes now, and how might the field contend with having others at its margins?
Whether and how impending bureaucratization places mad studies into existential risk are largely academic concerns. And yet these academic concerns raise, once more, concerns about mad studies becoming disconnected from its historical grounding in communities and activism, potentially both within and without the academy. Without such grounding, it is difficult to conceptualize mad studies as an intervention at all. And with such grounding, it becomes crucial to explore what makes academic legitimacy appealing or how that legitimacy might advance mad communities and activist efforts. Of course, critiques of academia, necessary as they may be, must be analytically distinguished from the enduring presence of mad people who have continued to survive, write, resist, and speak against overwhelming structural barriers. These acts of persistence and knowledge production exist in tension with, but are not erased by, the institutional limitations of the academy. For decades, mad studies remained unpopular and scholar-activists who took on this work often did so at the cost of their competitive academic careers. The exponential growth and fast popularity of mad studies is not necessarily an outgrowth of the field’s psychiatric survivor and mad activist roots, and this break in history is something that both seasoned mad scholars and those new to the field must contend with. In this introduction and through this special issue, we have tried to foreground the urgency of historical reckoning, the persistence of mad resistance, and the need for ongoing collective work.
As should be clear by now, we have left out many important elements and histories of mad studies, a move which aside from our own perspectives and authorial decisions, perhaps highlights the break in history between the past and present of mad studies that we are identifying. For example, our taking up of disability studies and neurodiversity speaks to current focus within mad studies on fluidity and queerness, departing from past grounding in class and feminism with a focus on homophobia and sexism within the psy complex. Similarly, historic coalitions between mad movements and Indigenous and other anti-racist activists are presently framed through decolonizing and globalizing mental health debates that move away from the histories and approaches of past intersectional activism. Finally, while we have barely focused on class or the accessibility of mad-focused work, the taking up of mad studies within the academy raises serious concerns about how this work relates to mad people who are not institutionally placed. Is contemporary mad work intended to be accessible to mad people outside the academy? Mad work that is published behind paywalls or written in language that is inaccessible to non-academics demonstrates the tensions between the stated aims of mad studies and the methods employed to achieve those aims. In moving a multiplicity of mad life, thought, perspectives, methods, and studies to the center, work done under the auspices of mad studies must navigate thoughtfully in order to realize the field’s transformative goals and resist reproducing the very hierarchies the field aims to dismantle. In presenting this open access special issue on mad methods, we hope this collection can contribute to and encourage further robust conversations about how to proceed in finding and honoring a multiplicity of paths toward a more just world.
